Accountability for Reasonableness for Priority Setting

Accountability for Reasonableness for Priority Setting Essay Accountability for Reasonableness, for priority setting and resource allocation. INTRODUCTION Pakistan as a developing country has very limited health care resources when  considering a huge population of over 170 million. We have very few tertiary care  hospitals and they are providing services to the whole country. Majority of people in  our country are poor and they are unable to afford the expenses of private hospitals,  though private hospitals are also very few. Thousands of doctors are unemployed  and still we have shortage of doctors. Majority of BHU (Basic Health Units) are  closed as majority of doctors belong to urban areas and they don’t want to work in  remote village areas. In all these situations, it is very difficult to maintain health  care throughout country. In this essay, I will take into account four conditions of  accountability for reasonableness for priority setting and resource allocation. I will  take into account these four conditions by Norman Daniels and I will consider a  tertiary care hospital scenario where I did my house job in medicine ward last year. There were majority of patients suffering from chronic liver diseases (CLD). I will  further continue this essay in discussion. DISCUSSION Before discussing the four conditions of accountability for reasonableness, I will  briefly discuss the case scenario. In my medicine ward as I earlier said majority of  patients were of chronic liver diseases (CLD) and it includes Hepatitis B, Hepatitis C  and cirrhosis of liver. Cirrhosis is the end result of hepatocellular injury that leads  to both fibrosis and nodular regeneration throughout the liver. The clinical features  result from hepatic cell dysfunction, portosystemic shunting, and portal  hypertension. Cirrhosis may cause no symptoms for long periods. One of the major  complications is uppergastrointestinal tract bleeding which may occur from varices,  portal hypertensive gastropathy, or gastroduodenal ulcer. Hemorrhage may be  massive, resulting in fatal exsanguinations or enencephalopathy. Esophageal varices  are found in 50 % of patients with cirrhosis. There are several treatment and  management options available for esophageal varices includin g acute resuscitation  as initial management, pharmacologic therapy, balloon tube tamponade, portal  decompressive procedures and emergent endoscopy. Endoscopic techniques are also  used for prevention of Rebleeding. 1. Now, I will discuss my case scenario. In our  hospital there is one associate professor who is trained in doing endoscopy and  Wednesday is fixed for performing endoscopies. Emergent endoscopy is performed  after the patient’s hemodynamic status has been appropriately stabilized (usually  within 2-12 hours). Majority of poor patients come to hospital in end stage liver  diseases. I have taken this case series as it is a perfect example of scarce resources. Many patients faced problems as their endoscopies were not performed on time as  there was only one day fixed in a week. Now I will apply the four conditions of  accountability for reasonableness for priority setting and resource allocation. These  four conditions are publicity condition, relevance condition, revisions and appeals  condition and regulative condition. Accountability for reasonableness makes it  possible to educate all stakeholders about the substance of deliberation about fair  decisions under resource constraints. It facilitates social learning about limits. It  connects decision making in healthcare institutions to broader, more fundamental  democratic deliberative processes. 2. In my case scenario I will apply the four  conditions as follows. The first one is publicity condition. It states that decisions  regarding limits to care and their rationales must be publicly accessible to clinicians,  patients, and citizens in a publicly administered system. When the patients suffer  the complication of esophageal varices, they are informed about the limited capacity  of the ward to arrange endoscopy as it is done on only Wednesdays and surgical  ward have their own burden of patients to be done endoscopies, due to this reason  we were unable to send patients to surgical wards and the patients and their  relatives mostly agrees on this setup and if their was any emergency only then we  take help from surgical ward or send the patients to any other hospital, so the first  condition is fulfilled. In above scenario second condition is also fulfilled which isrelevance condition. It states that the reasons for limit-setting decisions will be  reasonable if it appeals to evidence, reason, and principles that are accepted as  relevant by fair-minded people who are disposed to finding mutually justifiable  terms of cooperation. In my case scenario the decision making is according to the  framework. The rationales w ere reasonable as it is evident that we had limited  facility of endoscopy and it was fairly accepted by patients and their relatives and  also by doctors and other hospital staff. In our setup priority was given to those  patients who needed emergency endoscopy rather than those who requires  endoscopy for diagnostic procedures. The third condition is revisions and appeals  condition. This condition is a very common problem in government hospitals and in  our scenario we request consultants from surgical ward to do emergency endoscopy  if we think patient is serious and he or she may die if the endoscopy is not  performed on time or in other case the other hospital is very far so that it will be late  if we send the patient to other setup and here comes the function of oncall  consultants also, the oncall consultants plays huge role in these emergency  situations. This third condition is a mechanism for challenge and dispute resolution regarding limit setting decisions, including the opportunity for revising decisions in  light of further evidence or arguments. 3. Thus we fulfill the third condition also by  revising our decisions as I explained above. The fourth and last condition is  regulative condition or enforcement. There is either voluntary or public regulation  of the process to ensure that conditions 1-3 are met. This condition is also fulfilled in  our setup as we communicate with the patient and their relatives about our limited  resources. We are able to convince patients in our case scenario. The hospital  leadership is constantly making efforts to meet the conditions of ‘accountability for  reasonableness’. 4. CONCLUSION In this essay I have discussed all four conditions of accountability for  reasonableness, for priority setting and resource allocation. ‘Accountability for  reasonableness’ is a framework that can be used to guide legitimate and fair priority  setting in health care organizations, such as hospitals. In our beloved country  Pakistan we have few government civil hospitals bearing the burden of millions of  population. We try our best to server the humanity. Iam not claiming this system a  perfect one, it needs a lot of improvement and the example is my case scenario in  which we have very limited resources. Government should establish civil hospitals in  small cities also and should increase their budget; they should recruit more doctors  and nurses as we have shortage. They should train doctors with latest equipments  and provide hospitals appropriate medicines. In addition to this all the hospitals  should be provided with computers and also be made online so that a data system  can be established and it can help the patients and also hospitals for future  reference. I will conclude by saying that in such scarce resources, government sector  hospitals are doing excellent job. REFERENCES Current Medical Diagnosis and Treatment 2004. 43rd edition. Norman Daniels. (2000). Accountability for reasonableness. BMJ; 321; 1300-  1301. D K Martin, P A Singer and M Bernstein. (2003). Access to intensive care  unit beds for neurosurgery patients: a qualitative case study. J. Neurol.  Neurosurg. Psychiatry; 74; 1299-1303. Jennifer AH Bell, Sylvia Hyland, Tania DePellegrin, Ross EG Upshur, Mark  Bernstein and Douglas K Martin. (2004). SARS and hospital priority setting:  a qualitative case study and evaluation. BMC Health Services Research, 4:36

Autobiography of a Classroom Essay

I am a very big classroom in a well-known public school. I cater to needs of the kindergarten class of the school, accommodating I think about eighty five children, a big number isn’t it? I understand that I am the best looking room in the school as, the very small children study here. I am very attractively decorated so that the little ones like to come here every day. The room that is me – is decorated with beautiful coloured pictures. The walls are a blend of some colours I do not know the names of. The furniture that is placed in the length and breadth of the room consists of small round tables to seat four children on each table, and the chairs are also tiny. That is not all, all the furniture is a mixture of many colours. When the children come inside the class they almost fight to sit on certain chairs. That makes me understand that they like the colours and fight for their favourite colours to sit on. At the top two ends of the length of the classroom there are two bigger tables and full size chairs for the teachers to sit. Since there are so many children there are two teachers while in other classes there is only one each. I am a treat for everyone to see. My pleasure knows no bounds when everyone who comes inside the class, admires me, appreciates my get up and the colours that don me. I have the twin advantage of being the most beautiful room in the school and also having the cutest of children coming to spend their time with me. Thus, my life is full of beauty, colour, noise and laughter and at times of course also crying and howling of the children. At times some new entrants to the school come to me with their mothers and, cry as if they had come to the slaughter house to be butchered. At such moments even by heart cries for the little ones and I wonder why man makes these little children come to study if they do not want to. I of course do not know how important studies are for human children, I only feel sad seeing the children cry. My life is full of a very busy schedule though very interesting. The routine of my daily life is so busy that, I do not get any relief for quite long hours. In the morning as early as 6 a. m. wo sweepers come open the lock of my room or rather me, and off they start working on me. They sweep my floor, squab it, dust each and every piece of the furniture in me. Thus, I get alerted as soon the room is unlocked. It is not even 8 a. m. when the little brats start pouring inside my body’s doors. At times they enter with so much noise that my whole body feels the rattle of it all. Their movements are so loud that now, I cannot even think of any rest. School bags get flung, tiffin boxes are strewn all about, water bottles are kept just anywhere and there is a lot of commotion all over. Soon the maid enters the room and keeps everything in order and my appearance at once improves and I look tidy and well kept. For these small ones the school hours are just three from, 8 a. m. to 11 a. m. These three hours is my duty time, and just is the time when I also get the day’s entertainment. Being a classroom for the Kindergarten children I get a great chance of hearing conversations between the teachers and the parents. Since this is the first time their children have entered school, parents devote a lot of time to talking about the school and its standards. At times I find that some parents are just too critical and, inspite of getting all the best in this school they always seem to be unhappy and dissatisfied with something or the other in the school. Such parents keep lecturing about things missing in the classroom, the school or even in the playground. When I hear such complaints, my heart sinks and I wonder if they will allow or not allow their children to come to me any more,. For such conversations I have understood that, these days parents pamper the children too much, and it seems that they can never yes, never be satisfied. I am quite surprised to see the vast difference in opinions. While on the one hand I, and also many parents think that I am very beautiful, well kept, and decorated, others of the same clan are always complaining of many defects in my appearance. This gives me a feeling of depression and I do wonder if I can do anything in the matter. After some thinking bouts, I realize that, I can do nothing to satisfy these unhappy parents. I am just here in the hands of the school authorities and stand here as and how they keep me. My working hours are just six, from 6 a. m. when sweepers enter to say 12 noon when I am locked after all children go. After my duty hours I just relax but also feel lonely. No matter what is said about me, I am thoroughly enjoying my life in the cute company of little children. Their company makes me also feel young though now I am quite old. Every summer vacation I am painted afresh, my furniture is painted, and, I am ready to welcome my little friends, new and old with a new look, new enthusiasm and renewed vigour. I pray that my life is forever allowed to remain so interesting and so relaxed. I just love all the children and teachers who come here to me, to work and play in the restricted area within my four walls.

Organizational Ethical Behavior Trends Essay - 1851 Words

Organizational Ethical Behavior Trends Value motivated ethical leadership is needed today. The world has such a diverse work force today, and managers must develop and empower workers to achieve organizational goals. One develops his or her ethics from his or her culture, ethnic background, and religious beliefs. This paper discusses the importance of ethics and technology in the managerial decision making process and work related stress. The influence of ethics on decision making Ethics is about making choices with integrity. The future will be different after a choice is made, sometimes dramatically different, and that is why ethical decision making is so important. The more difficult the ethical choice one faces, the more†¦show more content†¦People sense same ethical dilemmas differently, and even those with ethical sensitivity may feel or understand the dilemma in different ways. For example, some may think reporting misconduct to supervisors outside the chain of command is an unethical act because it is disrespectful to the immediate superior. Some, however, believe that such an individual act, as long as benefiting the general welfare of the group, is not in violation of a code of ethics (Fang, M., 2006). It is important to understand an ethical dilemma before the actual decision-making process begins. Once the dilemma has been identified, individuals will start engaging in moral reasoning. However, a morally right judgment will not necessarily lead to moral behavior. The decision-making process involves many other concerns, including self-interests. For example, a person understands that giving out company secrets to competitors is morally wrong but may still decide to do it out of self-interest. The reason is that he of she fails to establish a moral intent which shows his or her resolution to act on a moral judgment. 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Abortion Is It Moral For The Right - 2128 Words

In today’s society, we often have to deal with many problems, such as financial, global warming, or cancer. Yet, abortion is still one of the most controversial topics of all time. Abortion is the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus (Webster). The conflicts between pro-life and pro-choice has been a long battle which lead to numerous disaster violent cases. The conflict of abortion may due to ethical issue, women’s constitutional right†¦etc. Pro-life supporters believe that abortion should be ban because abortion is inhumane. Pro- choice supports stance on abortion is that women have the right to make their own choice. When does life begin? Is it moral for abortion? Questions like these should be considered when deciding if abortion permissible. 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